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B rief C O M M U N I C A T I O N

Body image satisfaction among female college students

A B S T R A C T Shweta Goswami, Sandeep Sachdeva, Ruchi Sachdeva1
Departments of Community Medicine & 1TB and Respiratory Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Address for correspondence: Dr.Sandeep Sachdeva, Department of Community Medicine, Pt. B.D. Sharma, PGIMS, Rohtak124001, Haryana, India. Email:drsachdeva@hotmail. com

Objective: To determine body image satisfaction among newly entrant women students in a professional institution. Materials and Methods: Acrosssectional study using body image satisfaction described in words was undertaken, which also explored relationship with body mass index(BMI) and other selected covariables such as sociodemographic details, overall satisfaction in life, and particularly in academic/professional life, current health status using 5item based Likert scale. Height, weight, hip and waist circumference measurement was carried out using standard protocol. Data collection was carried through personal interview using predesigned, pretested semistructured interview schedule by female investigators during AugustSeptember 2010 and analysis carried out by computing percentages and Chisquare test. Results: Out of 96 study samples, 16.66%, 51.04%, and 32.29% girl students perceived their body image as fair, good and excellent, respectively while overall 13.54% were dissatisfied with their body image. The body image satisfaction had significant relationship with image perception(P<0.001), current general health status(P<0.001) and self weight assessment(P<0.001). Mothers education had a statistically significant(P=0.004) but negative relationship with outcome variable. Students with low weight (BMI<18.5kg/m) had a significantly higher (85.71%) prevalence of body image satisfaction while overweight students(BMI23kg/m) had a significantly higher(54.54%) prevalence of dissatisfaction(P<0.001). Discussion: High body image satisfaction is reported in this study and was found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style. Keywords: Aneamia, body image, body mass index, education, nutrition, obesity, perception, physical activity, satisfaction, students, women

he concept of body image as a psychological phenomenon was initially established in 1935, by the Austrian psychiatrist Paul Ferdinand Schilder(18861940), who said that the mental images that individuals have of their own bodies explain the way their bodies are introduced to them. According to the psychiatrist, ones mental body image is established by senses, ideas and feelings that, most of the time, are unconscious. This representation is built and rebuilt throughout life.[1,2] Body image is a multidimensional dynamic construct that involves internal biological and psychological factors as well as external cultural and social determinants.[3,4]
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Individuals who perceive their bodies negatively with regard to culturally valued features may have low selfesteem, low satisfaction in life and feeling of inferiority and pose themselves at higher risk for depression, anxiety or eating disorders. At the highest level of dissatisfaction, this may result in significant impairment of social, educational and/or occupational functioning. Currently, beautiful is considered good and thinness is synonymous with beauty, which makes it valued by society while its opposite, obesity, is strongly rejected. Although the ideals of female beauty vary as a function of esthetical standards adopted at each time, studies show that women have tried to change their bodies to follow these standards.[5] Obesity has been identified as one of the rising epidemic across globe with consequential rise of noncommunicable diseases including disproportionate health care cost on individuals, family and society. According to latest WHO estimates, 14.4%(male) and 15%(female) adult aged
168 Industrial Psychiatry Journal

DOI: 10.4103/0972-6748.119653

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Goswami, etal.: Body image satisfaction

15years and above are obese in the world.[6] More than half a billion adults(205 million men and 297 million women over the age of 20years) worldwide were obese in 2008. The prevalence of overweight and obesity was highest in WHO regions of America and lowest in SouthEast Asia.[7] Overweight children, adolescents, and adults generally have lower body esteem than do their normalweight peers and this is especially true for females.[8] It is generally believed that body image distortion and related consequences is a western societal phenomenon however, it has made its presence felt into diverse culture including developing countries also. With the change in epidemiological shift, India is witnessing simultaneous manifestation of double burden of communicable and noncommunicable disease with a challenging and daunting task for stakeholders to identify issues, resolve conflict, mobilize resources and overcome situation with innovative solution and strategies. Considering this background, a crosssectional descriptive study sought to determine body image satisfaction, a hitherto underexplored arena in our setting. Using body satisfaction described in words, this study also investigated relationship with body mass index(BMI) and other selected covariables. MATERIALS AND METHODS The study variables included body image satisfaction, overall satisfaction in life, and particularly in academic/ professional life, current health status and body image perception through self rating on 5items based Likert scale(poor, fair, good, very good and excellent). Other variables included were related to native place, type of family, social caste, marks obtained in qualifying exam(12 thclass), education of mother and father, monthly family income, siblings and self assessment of weight into lean(underweight), normal, overweight/ obese category. Attempt at changing weight was inquired, if undertaken during last oneyear and whether meals were skipped as a method of dieting during last three months. Physical activity considered in present study was: 30min of intense physical/sports activity that lead to large increase in breathing/heart rate and undertaken for atleast 45days/week(regularly); 13days/week(sometimes) and none. Height, weight, hip and waist circumference measurements were carried out for each candidate using standard protocol under comfortable conditions after adequate rest in order to compute BMI(kg/m2) and waist/hip ratio, as applicable to Asian citizens.[9] Body weight of the candidate wearing light clothing and without footwear was measured to the nearest 0.5kg using a weighing scale; height was assessed to the nearest 0.1cm by using a non elastic measuring tape
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with the participant standing erect against a wall, without shoes and the head looking straight. Midpoint of inferior margin of last rib and the crest of ilium was measured for waist circumference. The hip circumference was measured around the maximum circumference of the hips. Waist hip ratio is related to the metabolic complications of obesity and criteria recommended by WHO, of absence of risk(<0.8) and risk of abdominal obesity(0.8), were followed. Hemoglobin status to determine presence/ absence of anemia(<12g/dl), as a routine health procedure investigated at the time of admission to institution, was also collected and recorded. Considering feasibility, all available newly entrant female students undergoing professional courses and residing in womens hostel were contacted. It was proposed for complete enumeration, however, out of a total of 101 resident students, 2 declined to participate, 3 could not be contacted despite of two repeat visits and 96(95.04%) consented to participate in this study. Data collection was carried through personal interview by the female investigator using predesigned, pretested semistructured interview schedules during AugustSeptember 2010 after taking informed consent of participants ensuring complete confidentiality in a nonjudgmental manner and at their convenient time. Data management was done using MS Excel and analysis was carried out by computing descriptive and inferential statistic(Chisquare test) using software statistical package(SPSS ver.16). For the purpose of analysis, Pvalue of less than 0.05 was considered significant and some items of scale was grouped into a single entity such as poor and fair, into fair, and very good and excellent, into excellent. RESULTS Out of 96 students who participated, 20.83%, 35.41%, and 43.75% were associated with BDS, MBBS and nursing streams, respectively; 67.70% belonged to rural background; 71.87% lived in joint family system; 51.04%, 37.5%, and 11.45% secured <80%, between 8090% and >90% marks in 12thclass. Mothers education of majority(54.16%) of participants was up to 12thclass, while majority(63.54%) of candidates fathers were atleast graduate; 41.66% had monthly family income between Rs. 20,00040,000 followed by 38.54% with>Rs. 40,000; 40.62% had sibling as brother only, 5.20% as sister only while 54.16% had both, Table1. Nearly, 16(16.66%), 49(51.04%), and 31(32.29%) female students perceived their body image as fair, good and excellent, respectively while overall 13(13.54%) were dissatisfied with their body image. Further analysis of body image satisfaction was carried out with selected
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Goswami, etal.: Body image satisfaction

variables and association was found to be statistically nonsignificant with professional stream( P = 0.058), native place(P=0.44), type of family(P=0.66), social caste(P=0.34), marks obtained in 12thclass(P=0.32), education of father( P = 0.28), monthly family income(P=0.10), gender of sibling(P=0.70), physical activity(P=0.41), global satisfaction in life(P=0.30) and satisfaction in academic life(P=0.76). Nearly 34.37% participants attempted at changing(increase/decrease) their weight(P=0.73) during last oneyear while 9.37% skipped at least one meal during last three months as a strategy for weight reduction(P=0.82). The body image satisfaction had significant relationship with image perception(P<0.001), current general health status(P<0.001) and self weight assessment(P<0.001). Mothers education had an inverse bearing on the outcome variable(P=0.004). According to BMI nearly 11.54% girls were found to be overweight(or obese) while 29.16% were undernourished; 26.04% had waist/hip ratio of more than 0.8 and was significantly related to body image. Nearly, 75% girls were found to be anemic but this was not statistically
Table 1: Sociodemographic profile of study participants
Variable Body image satisfaction(%) Unsatisfied (n=13) Native Urban Rural Type of family Nuclear Joint Social cast General Affirmative group Marks(12thclass) <80% 80% Education of mother* Up to 12thclass Graduate/above Education of father Up to 12thclass Graduate/above Monthly family income (Rs.) <20000 20-40000 >40000 Sibling(s) Brother only Sister only Both 03(23.07) 10(76.92) 10(76.92) 03(23.07) 03(23.07) 10(76.92) 05(38.46) 08(61.53) 03(23.07) 10(76.07) 03(23.07) 10(76.07) Satisfied (n=83) 28(33.73) 55(66.26) 59(71.08) 24(28.91) 36(43.37) 47(56.62) 44(53.01) 39(46.98) 58(69.87) 25(30.12) 32(38.55) 51(61.44) Total(%) (n=96)

related to body image in the sampled population(P=0.86), Table2.

Table2: Body image satisfaction according to selected variables
Variable Body image satisfaction(%) Unsatisfied (n=13) Attempted at changing weight (increase/decrease) No Yes Skipped meal as a method of dieting No Yes Physical activity Never Some times Regularly Global satisfaction in life Fair Good Excellent Satisfaction in academics/ professional life Fair Good Excellent Current status of general health* Fair Good Excellent Body image perception* Fair Good Excellent Self assessment of weight* Lean Normal Overweight BMI(kg/m2)* <18.5 18.5-23.0 23.0 Waist/hip ratio* <0.8 0.8 Anemia Absent Present Satisfied (n=83) Total(%) (n=96)

08(61.53) 05(38.46)

55(66.26) 28(33.73)

63(65.62) 33(34.37)

12(92.30) 01(7.69) 05(38.46) 01(07.69) 07(53.84)

75(90.36) 08(9.63) 19(22.89) 14(16.86) 50(60.24)

87(90.62) 09(09.37) 24(25.00) 15(15.62) 57(59.37)

02(15.38) 07(53.84) 04(30.76)

11(13.25) 28(33.73) 44(53.01)

13(13.54) 35(36.45) 48(50.00)

31(32.29) 65(67.70) 69(71.87) 27(28.12) 39(40.62) 57(59.37) 49(51.04) 47(48.95) 61(63.54) 35(36.45) 35(36.45) 61(63.54)

03(23.07) 05(38.46) 05(38.46)

15(18.07) 27(32.53) 41(49.39)

18(18.75) 32(33.33) 46(47.91)

08(61.53) 05(38.46)

08(9.63) 40(48.19) 35(42.16)

16(16.66) 45(46.87) 35(36.45)

11(84.61) 02(15.38)

05(6.02) 47(56.62) 31(37.34)

16(16.66) 49(51.04) 31(32.29)

03(23.07) 04(30.76) 06(46.15) 04(30.76) 03(23.07) 06(46.15) 05(38.46) 08(61.53) 03(23.07) 10(76.07)

05(6.02) 69(83.13) 09(10.84) 24(28.91) 54(65.06) 05(6.02) 66(79.15) 17(20.48) 21(25.30) 62(74.69)

08(08.33) 73(76.04) 15(15.62) 28(29.16) 57(59.37) 11(11.45) 71(73.95) 25(26.04) 24(25.00) 72(75.00)

01(7.69) 09(69.23) 03(23.07) 09(69.23) 04(30.76)

18(21.68) 31(37.34) 34(40.96) 30(36.14) 05(6.02) 48(57.83)

19(19.79) 40(41.66) 37(38.54) 39(40.62) 05(05.20) 52(54.16)

*Statistically significant(P<0.05); figure in bracket indicate percentage

*Statistically significant(P<0.05); figure in bracket indicate percentage, BMI Body mass index

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Goswami, etal.: Body image satisfaction

DISCUSSION A study was undertaken to determine body image satisfaction and perception among newly entrant girl students(1722years) of a professional institution. In the present study nearly 83.33% rated their perceived body image from good to excellent while overall 13.54% were dissatisfied with their image. Our study reports a relatively lower proportion of body image dissatisfaction among college going girl students in comparison with other selected studies done at international platform. The study methodology may differ but on review of literature, level of body image dissatisfaction ranged from 33%(China), 34.9%(Australia), 45%(Greece), 47.3%(Brazil), 50%(Taiwan), 56%(Norway), 29.8% and 56.7%(Turkey), 69%(European Union), and 73.3%(USA).[1018] Probably culture, upbringing, professional stature and ethnicity may be some predominant factors behind high body image satisfaction, as another study carried out in UK also reported that Asian women were less likely to describe themselves as too fat, were less dissatisfied with their body size, and less likely to want to lose weight in comparison with white women.[19] The other possibility of low dissatisfaction could be that the first year students have just emerged from the protected environment of their family and may throw surprising results if study is repeated after few years when they are exposed to more competitive situations later in life. On the contrary, a study conducted amongst all resident medical female students in south India reported image dissatisfaction to the tune of 33.3%.[20] Similar results were observed from another study conducted in Karnataka, with 29.1% underweight girl students but only 3.2% being overweight while more than 65% perceived themselves to be either slim or thin.[21] Astudy carried amongst nursing students(mean BMI: 20.14) in West Bengal also revealed double burden of nutritional disorder with prevalence of faulty weight perception of 38.6% and was found to be weighted towards feeling higher weight.[22] In study conducted in Delhi, half of overweight/obese youth had low body satisfaction, while onequarter of the nonoverweight youth felt the same; among overweight/ obese youth, girls were more likely than boys to perceive themselves as overweight(P=0.047) and to have low body satisfaction(P=0.052).[23] In Lucknow, 73.4% adolescent girls were satisfied with their body image, while 26.6% were dissatisfied.[24] In the present study(mean BMI: 20.13), nearly 15.62% perceived themselves to be overweight/obese while actually 11.54% could be grouped into this category(BMI >23kg/m2). Similarly, 8.33% perceived themselves to be underweight/lean but infact 29.16% were found to be so(BMI <18.5kg//m2). Students
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with low weight(BMI <18.5 kg/m) had a significantly higher(85.71%) prevalence of body image satisfaction while overweight students(BMI23kg/m) had a significantly higher(54.54%) prevalence of dissatisfaction(P<0.001). Body image satisfaction had significant relationship with BMI and waisthip ratio in the present and was similar to as reported in other studies. Further, higher proportion of dissatisfaction was found amongst subjects with higher level of mothers education probably due to increased aspiration and expectations in life. The burden of undernutrition including anemia is widespread amongst Indians especially the vulnerable groups. According to community based National Family Health Survey(NFHS3 survey, nearly 36% of women are undernourished(BMI <18.5) while the percentage of married women age 1549 who are overweight or obese, increased from 11% in NFHS2(199899) to 15% in NFHS3(200506) and almost half of the girls in age1519 were undernourished. District Level Household Survey(DLHS) and Indian Council of Medical Research surveys have repeatedly shown that over70% of preschool children, adolescent girls and pregnant mothers are anemic.[25] Akin to this observation, our study also reflected similar situation with 75% of girls being anemic who need adequate and priority management. Authors acknowledges some of the limitations of our study such as small sample size; possibility of underreporting; nonuse of scales like visual analog, figure rating or contour drawing comparison scale etc. Similar studies may be undertaken at other centers in India to determine frequency/variations/trends overtime with inclusion of male member of society also. To conclude, high body image satisfaction is reported in this study and found to be significantly related to anthropometric measurements. On an encouraging note, this level needs to be preserved for overall mental and healthy development of students. Proactive preventive measures could be initiated in institutions on personality development, acceptance of self and individual differences while maintaining optimum weight and active life style. ACKNOWLEDGMENT
ViceChancellor and Director, University of Health Sciences, Rohtak, India.

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Goswami, etal.: Body image satisfaction

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How to cite this article: Goswami S, Sachdeva S, Sachdeva R. Body image satisfaction among female college students. Ind Psychiatry J 2012;21:168-72. Source of Support: Nil. Conflict of Interest: None declared.

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